基于危害分析与关键控制点理论的边缘型人格障碍住院患者非自杀性自伤行为护理管理实践

目的 探索危害分析与关键控制点理论在边缘型人格障碍住院患者非自杀性自伤行为护理管理中的应用和效果。方法 以某三级甲等综合医院心身疾病科边缘型人格障碍住院患者为研究对象,制定纳入排除标准,选取2020年度182例边缘型人格障碍患者作为对照组,实施精神专科护理常规及风险管理;选取2021年度边缘型人格障碍患者175例作为观察组,在实施精神专科护理常规及风险管理基础上,借鉴危害分析与关键控制点的原理和步骤,组建危害分析与关键控制点项目小组,制定工作计划,对边缘型人格障碍患者非自杀性自伤行为进行危害分析和护理风险评估、防控关键控制点,实施住院全周期护理安全管理。比较2组边缘型人格障碍患者非自杀性自伤行为干预效果。结果 2组边缘型人格障碍患者一般人口学资料及住院前非自杀性自伤行为发生率比较,差异无统计学意义（P>0.05）;与对照组比较,观察组患者非自杀性自伤行为发生率减少（P=0.001）,非自杀性自伤行为对身体伤害严重程度降低（P=0.014）,差异有统计学意义（P<0.05）。结论 运用危害分析与关键控制点原理和步骤组建项目小组,对边缘型人格障碍住院患者非自杀性自伤行为进行护理干预,有利于减少边缘型人格障碍患者非自杀性自伤行为发生率,降低非自杀性自伤行为对身体伤害严重程度,提高护理质量、保障患者安全。

Nursing Management of Non-suicidal Self-injury in Inpatients with Borderline Personality Disorder Based on Hazard Analysis Critical Control Point

Objective To explore the effect of hazard analysis and critical control point (HACCP) in nursing management of non-suicidal self-injury behavior (NSSI) in inpatients with borderline personality disorder (BPD). Methods BPD inpatient in a tertiary grade-A general hospital was recruited with determined inclusion and exclusion criteria. A total of 182 objects in 2020 were included as control group, receiving routine psychiatric care and risk management, and another 175 patients in 2021 as experimental group, in which a novel model of nursing management was implemented. A team was established based on the principles and steps of HACCP. Hazard analysis of NSSI behaviors, nursing risk assessment and critical control points in patients with BPD was conducted, then nursing safety management was implemented. The intervention effect on NSSI behaviors in the two groups were compared. Results There was no significant difference between both groups on demographic variable (P>0.05) and NSSI behaviors at baseline (P>0.05). Compared to those in the control group, NSSI behaviors of patients in the experimental group showed significant decrease in incidence of NSSI behaviors (P=0.001) and severity of physical harm (P=0.014). Conclusion HACCP in psychiatric nursing management help to decrease the occurrence and severity of NSSI behaviors in inpatients with BPD, thus to improve the quality of nursing and patient safety.